Print out this form, fill out and return to Deborah Kaplan
701 Oxford Road, Bala Cynwyd, PA 19004-2111
Fax (610) 667-2859 * Phone(610) 667-5889

A check for $247 should be mailed to Deborah with this order
Please call with any questions

Sold to: _________________________________
Phone: _________________________________
Fax: _________________________________

Ship to: _________________________________
______________________________________
______________________________________
______________________________________
______________________________________

Name of Ketubah:_______________________________
Text: Egalitarian ____ Traditional ___
Conservative ___ All English ___ (Great Circle only)

Bride
English Name: _________________________________
Hebrew Name: _________________________________
English Transliteration: _________________________________

Bride's Mother
English Name: _________________________________
Hebrew Name: _________________________________
English Transliteration: _________________________________

Bride's Father
English Name: _________________________________
Hebrew Name: _________________________________
English Transliteration: _________________________________

Groom
English Name: _________________________________
Hebrew Name: _________________________________
English Transliteration: _________________________________

Groom's Mother
English Name: _________________________________
Hebrew Name: _________________________________
English Transliteration: _________________________________

Groom's Father
English Name: _________________________________
Hebrew Name: _________________________________
English Transliteration: _________________________________

Wedding Date: _________________
After Sunset? __________
Place of wedding:
City: ___________________ State: ____________
Person to call with questions: ____________________________
Phone: _________________________________
Fax: _________________________________

The rest of this form is for Traditional or Conservative Texts only
Check if Bride's father is a Levite ___ Cohain ___
Check if Groom's father is a Levite ___ Cohain ___

Bride is Single ___ Divorced ___
Widow ___ Convert ___

Is Bride's father alive? _____
Blue Rings Ketubah
The Great Circle Ketubah
Gold Rings Ketubah
Arches Ketubah